Age related Oral Changes Flashcards
What important things should be considered with older patients?
Psychological and physical aspects.
What are the general hallmarks of aging?
Age related changes that manifest themselves during normal aging.
Its experimental aggravation should accelerate aging.
its experimental amelioration should retard the normal ageing process and, hence, increase healthy lifespan
What are the theories associated with aging?
DNA damage
Free radical theory (oxidative stress)
Telomeres
How does risk of death increase with age?
After 30 chance of death doubles every 8 years.
What is the most effective proven way to slow down aging?
Caloric restriction associated with slowing down aging.
What happens to risk of diseases with age?
They peak at age 70
What are the factors that contribute to aging process?
Genomic instability
Telomere attrition
Epigenetic alterations
Loss of proteostasis
Deregulated nutrient-sensing
Mitochondrial dysfunction
Cellular senescence
Stem cell exhaustion.
What is genomic instability?
Accumulation of genetic damage throughout life.
Premature aging diseases such as Werner syndrome and Bloom syndrome are a result of increased DNA damage accumulation.
What causes genomic instability?
Can be internal.
The integrity and stability of DNA is continuously
challenged by exogenous physical, chemical and
biological agent
What kind of changes happen in the genome leading to instability?
Somatic mutations accumulate within cells from aged humans and
model organisms
Other forms of DNA damage, such as chromosomal aneuploidies
and copy-number variations have also been found associated with
aging
All these forms of DNA alterations may affect essential genes and
transcriptional pathways, resulting in dysfunctional cells that, if not
eliminated by apoptosis or senescence, may jeopardize tissue and
organismal homeost
What does oxidative stress do to lead to aging?
ROS can affect proteases and lead to aggregation of proteins.
How do hallmarks lead to formation of aged cells?
Primary hallmarks (genomic instability, telomere attrition, and epigenetic alterations) associated with causing damage, antagonistic hallmarks are altered thus response to damage is altered, and integrative hallmarks are culprits of the phenotype.
What happens during aging (overview)?
A decrease in the amount of tissue, usually secondary to an acquired imbalance in matrix synthesis and breakdown.
Altered molecular composition of the matrix,
particularly post-translational modification of structural proteins such as collagen and elastin.
Accumulation of degraded molecules in the matrix.
Reduced efficiency of function
What common conditions are related to age?
Atherosclerosis and CVDs.
Hypertension
T2DM
Cancer
Arthritis
Cataracts
Osteoporosis
Alzheimer’s disease
What is the effect of atherosclerosis and CVD?
Fatigue and less resistance to stress
What effect has fluoridated water and routine dental care had on oral health?
Reduced edentulism rate
What happens to patients that are edentulous?
They have reduced masticatory efficiency (300 lbs/square inch with natural teeth to 50 lbs/square inch with dentures)
Alveolar ridge absorption (50% within 2 years of extractions)
Speech function
Loss of vertical dimension
Candidosis is common condition (denture caused mucositis)
Epithelial hyperplasia
What are the oral manifestations of aging.
Hyperkeratosis
Dental caries (root caries)
Salivary glands
Periodontal disease
Oral cancer
Issues related to dentures
Lips
Oral mucosa
Tongue
Enamel
Cementum
Dentin
Pulp
Alveolar bone
What happens to dental hard tissue with aging?
Increased dentin thickness and permeability (sclerosis of dentinal tubules causes this) leading to diminished pulp space, diminished sensitivity of dentin to effects of bacterial metabolites, and increased tooth brittleness.
What happens to dental pulp with aging?
Decreases in volume and shift in proportion of nervous, vascular, and connective tissues leading to diminished reparative capacity as well as sensitivity, and alteration in nature of sensitivity.
What happens to salivary glands with aging?
Fatty replacement of acini leading to possibly less physiologic reserve.
What happens to the tongue with aging
Atrophic glossitis which means atrophy of the lingual papillae and reduced taste sensations as well as increased threshold for sweet and salty food.
No reduction in number of taste buds.
In some cases there are sublingual varicosities.
What other changes can affect oral mucosa with age?
Decreased salivary secretion (can be primary or secondary to disease or meds)
Atrophic changes (thiinner, less vascular, less elastic, and appears smoother and shinier)
Hyperkeratosis (due to chronic irritation)
Candidiasis
Capillary fragility (leading to haematomas and petechiae)
What other chagnes can affect the lips with age?
Tissue changes such as dryness, loss of elasticity, and a thin vermillion border
Angular cheilitis ?caused by? loss of vertical dimension and candidiasis / vitB
What happens to enamel with aging?
Enamel becomes brittle and thin due to reduced blood flow.
Loss of translucence
Abrasion and attrition
What happens to dentin with aging?
Formation of secondary dentin (response to prior trauma, and decreased pulp chamber)
Increased thickness
Yellowing (due to increased thickness of dentin)
What happens to pulp with aging?
Narrowing of pulp chambers due to entry of 2ndary dentin
Fibrotic
Reduced blood supply (less cellular)
Pulp stones
What happens to cementum with aging?
Attachment is lost (periodontal ligament) leading to increased incidence of periodontal disease.
Increased thickness of cementum.
What happens to alveolar bone with aging?
Decreased blood flow
Osteoporosis (bone quality that is less dense)
Bone loss is not an inherent part of aging.
What happens to incidence of caries witha ge?
Increases with age in root but decreases in crown. (Gum recession)
These are due to xerostomia and reduced physical dexterity
What are the risk factors for caries that increase in elderly?
Dry mouth
Poor oral hygiene
Gingival recession
Cognitive or physical impairments
High number of bacteria
High carbohydrate diet
Partial dentures
Access to care
What increased risk of periodontal disease in elderly?
Potential for osteoporosis
Decreased tissue vascularity
Increased risk for infection
Xerostomia
Chronic disease and reduced physical dexterity (altered immune response, medication side effects, and plaque removal skills)
Who is oral cancer more common in?
Increased incidence with age (increased at age 40 and again at age 60)
Males more than females
What are the oral side effects of cancer treatment?
Xerostomia
Oral ulcerations
Osteoradionecrosis
Mucositis, trismus, and radiation caries.
What issues are related to dentures?
Loss of vertical dimension
Angular cheilitis
Denture stomatitis
Inflammatory papillary hyperplasia (mainly seen on the hard palate)
Epulis fissuratum
What is epulis fissuratum?
Flanks of excessive mucosal tissue where the denture clamps are
What structure’s function can be affected by polypharmacy most intensely?
Salivary glands; mainly the minor salivary glands.
What causes xerostomia?
Xerostomia is secondary to disease/medications:
caries, dry lips, painful mucosa, dysphagia, taste acuity
Xerostomia is NOT
a part of normal aging
What drugs can induce drug related changes commonly affecting the gingiva?
Drug induced gingival hyperplasia can be caused by:
Phenytoin (for epilepsy)
Ca2+ channel blockers
Cyclosporin
Which illnesses often have an oral-systemic link?
Diabetes
Cardiovascular disease
Respiratory illness
What does porphorymonas gingivalis infection do?
Reported to be involved in the development of systemic diseases
Due to systemic inflammation with
Increased circulating cytokines and
mediators
Direct infection
Cross-reactivity/molecular mimicry between bacterial antigens and self-antigens
What effect can diabetes have on the oral cavity?
Oral complications
Exacerbation of periodontal disease (periodontal disease more frequent, progression of periodontal disease more rapid, healing following surgery may be delayed, Increased likelihood of infection)
Candidiasis is more common in diabetic patients
Xerostomia issues (possibly due to poor glycaemic control)
What link has been found between periodontal disease and CVD that have been observed?
From the Oral Cavity:
Macrophages, Neutrophils, Toxins, anaerobic bacteria in plaque
Circulating inflammatory mediators (fatty acids, interleukin 1, tumor necrosis factor alpha)
Acute phase proteins
– CRP, SAA, IL6, TNF alpha
To the Heart:
Heart and blood vessels, endothelial injury, lipid deposition, monocyte migration, smooth muscle proliferation
Atherosclerosis, CVD, stroke
What association has been seen between respiratory illness and the oral cavity?
Good evidence that improved oral hygiene and frequent professional oral healhcare reduces progression or occurence of respiratory diseases in high risk elderly patients
(relative risk reduction 34 - 83%)
